RESUMENES

The role of plasma oncotic pressure in the macrosomic and hyperinsulinemic newborn
Y. Galib Fiol MD1; M. S. Correa-Rivas MD1; K. Adamsons MD, PhD2; 1 Department of Pathology and Laboratory Medicine, 2 Department of Obstetrics and Gynecology, Medical Sciences Campus, University of Puerto Rico.

Medical literature has remained virtually silent regarding topics such as arteriolar conductance and plasma oncotic pressure. Since arteriolar conductance is the main determinant of capillary blood pressure, and never exceeds the oncotic pressure of plasma, the clinician is rarely confronted with situations in which this regulatory process fails. The hyperinsulinemic macrosomic newborn of the diabetic mother is one of the rare exceptions. It is expected that arteriolar conductance in the newborn is high. Under normal circumstances the high conductance is compensated by the low inotropism of the ventricles protecting the newborn from developing pulmonary edema, hypovolemia, and hemoconcentration. The myocardial hyperplasia of the hyperinsulinemic newborn changes the previous balance, unless it is compensated by the needed hyperplasia of the arterioles. Irrespective of the protective action of the arterioles, the plasma oncotic pressure is likely to play a decisive role. We present two macrosomic newborns who died within 18 hours after birth with plasma albumin less than half the calculated optimum. The histopathologic changes in the liver of these macrosomic babies question the hepatic functional capacity to synthetize the needed albumin to maintain a pressure of 30 torr. Restauration of optimal albumin levels should be considered to maintain the oncotic pressure and avoid the possible consequences of hypovolemia, hemoconcentration, and increased blood viscosity worsening oxygenation in these newborns who suffer pulmonary hypertension among other problems.

Promoting Neurological Recovery following Traumatic Nerve Injury. I. SOSA 1; J. SANTIAGO 2; O. REYES 3; D. KUFFLER 4. 1 Section of Neurosurgery, 2 Department of Orthopedic Surgery, 3 Doctors Center Hospital, Manati, 4 Institute of Neurobiology, Medical Sciences Campus, UPR.

Each year over 50,000 people in the US suffer peripheral nerve traumas requiring surgical repair. Only 10-20% recover moderate to normal neurological function because of the lack of a reliable technique for inducing axon regeneration across gaps >0.5 cm. We are testing a new technique for its ability to restore neurological function after traumatic peripheral nerve injuries. The technique requires two materials, a tube of exogenous collagen to bridge the nerve gap, and a 3-dimensional matrix filled with neurotrophic and wound healing factors. We repaired nerve gaps from 2-12 cm, 3½ weeks to 3½ years post trauma. Each of 4 patients recovered neurological function, quantitatively assessed from limited to normal. At a minimum, each patient recovered movement of some fingers, the ability to generate force, and skin sensitivity appropriate for the repaired nerve. The latency of evoked potentials approached normal. There was neurological recovery even with a 12-cm gap repaired 3½ years post trauma. The best recovery was in a patient with a 5 cm gap repaired 3½ weeks post trauma with normal muscle control and force generation, normal conduction latency, and sensitivity to vibration, temperature and touch, with normal 2-point discrimination. Following surgery, each patient had from significant reduction to complete elimination of pain associated with the injury. Theses results indicate that, using a simple technique, neurological function of lesioned peripheral nerves can be restored, even across long nerve gaps, and at long times post trauma, but the best recovery is when the repair is performed as soon after the trauma.

Can humans recover function following paraplegia? O. REYES I; I. SOSA 2; R. BRAU 2; D.P. KUFFLER 3. 1 Doctors Center Hospital, Manati; 2 Division of Neurosurgery, 3 Institute of Neurobiology, School of Medicine, UPR.

There is no neurological recovery following a spinal cord lesion in humans because the spinal cord tissues contains factors that inhibit axon regeneration, and lack factors to promote axon regeneration. Although a technique has been developed for inducing neurological recovery in an animal model, there is no reliable technique that can be applied clinically to humans. Here we present preliminary results from a small clinical study in which we applied a novel technique in an attempt to induce neurological function in patients with an anatomically lesioned spinal cord. The patients had spinal cord gaps of from 2-5 cm long. The gaps were bridged with a collagen tube filled with a patient-derived 3-dimensional matrix containing neurotrophic and wound healing factors. One patient recovered no neurological function. However, two patients recovered some neurological function. They developed sensitivity in one leg, and could localize which leg, as well as where it was stimulated. In addition, and one of these patients developed sensitivity to temperature and vibration. This patient also developed bladder and bowl sphincter control, and sensitivity in his genital area. To our knowledge, these are the first cases in which humans have recovered neurological function following a complete anatomical spinal cord transection. Although the recovery was limited, the results suggest that even simple modifications of this technique should lead to more extensive neurological recovery. Further studies are required to determine the reliability of the technique, and when is the optimal time post trauma to perform the lesion repairs.

Outcomes of a Community Pharmacy-Based Pharmaceutical Care Program for Patients with Diabetes. F.J. Jiménez-Ramírez; H.A. Monsanto-Planadeball. Department of Pharmacy Practice, University of Puerto Rico School of Pharmacy.

A Pharmaceutical Care Program was implemented to assess clinical and humanistic outcomes with patients serving as their own control. Diabetes Mellitus (DM) is the third leading cause of death in Puerto Rico. Puerto Ricans are among the high risk ethnic groups to develop DM and related complications. Glucose control has been directly related to prevention of chronic diabetes related complications. Patients were recruited, educated and evaluated prospectively as approved by the UPR Medical Sciences Campus IRB. Inclusion criteria were: (1)diagnosis of type 1 or 2 DM, (2)18 years of age or older, (3)willingness to participate and comply with follow-up appointments. A structured educational program and assessment was provided by a pharmacist who is also a Certified Diabetes Educator and a nutritionist. Clinical (glycosilated hemoglobin A1c) and humanistic (quality of life and patient satisfaction) outcomes were measured. One hundred fifty-nine patients were enrolled in the program and 70 % remain active. Average age was 59 ± 11.7 years, primarily females (73%). The average glycosilated hemoglobin at baseline was 8.65 ± 2.18 % compared to 7.69 ± 1.47 % at the end of the period analyzed (N=71, p=0.003). There was a significant improvement in diabetes knowledge score from baseline (67%) to one year after (80%), p < 0.01. Satisfaction with pharmacist services improved slightly from baseline to one year after (p=0.06). A community pharmacy-based pharmaceutical care program for patients with DM was successful improving outcomes and diabetes related knowledge. Supported by: AADE, Aventis, Farmacia San José, and UPR-School of Pharmacy.

Precision and Accuracy of Measurements between 3D and Traditional Orthodontic Models. A.V. García Motta, A.R. Elías-Boneta,C. Toro,K. Psoter, School of Dentistry, University of Puerto Rico, Medical Sciences Campus.